Healthcare Provider Details

I. General information

NPI: 1003869421
Provider Name (Legal Business Name): STEPHEN MATTHEW CLEMENTS P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 S 300 E SUITE300
MURRAY UT
84107-6178
US

IV. Provider business mailing address

5810 S 300 E SUITE300
MURRAY UT
84107-6178
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-2225
  • Fax: 801-314-2345
Mailing address:
  • Phone: 801-314-2225
  • Fax: 801-314-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5972740-8906
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: